药物干预对动脉导管未闭介入治疗后心脏重构的影响

Effect of drug on left heart remodeling after transcatheter closure of patent ductus arteriosus with domestic occluder

目的:研究应用国产动脉导管未闭(PDA)封堵器介入治疗PDA后心脏重构的变化规律,评价培哚普利对PDA患者封堵后左心大小、功能和肺动脉收缩压的作用。方法:26例PDA患者中25例经国产封堵器封堵后选择经胸超声心动图(TTE)测得PDA5.0mm的成人患者(年龄>17岁)20例,按性别相等、年龄±5岁分成治疗组和对照组,2组均常规术前1d开始予肠溶阿司匹林200mg.d-1×1个月,然后100mg.d-1×5个月,治疗组加服培哚普利2mg.d-1×6个月。术前、术后6个月经TTE和心电图(ECG)检查。心室容积和射血分数采用面积长度法测定,连续多普勒根据三尖瓣反流估测肺动脉收缩压。结果:2组基础指标,如左房内径(LAD),左室舒张末内径(LVEDD),左室收缩末内径(LVESD),左室舒张末容积(LVEDV),左室收缩末容积(LVESV),左室搏出量(LVSV),肺动脉内径(PD),肺动脉收缩压(PSP)均差异无统计学意义(P>0.05)。培哚普利治疗6个月后,LVEDD、LVESD、LVEDV、LVESV、LVSV、LVEF、FS、PD、PSP治疗组均较对照组有明显的改善(均P<0.05)。结论:培哚普利能明显改善PDA封堵术后患者的左心功能和形态,并使肺动脉内径缩小、肺动脉收缩压降低,临床症状明显改善。

Objective：To assess the regular change of cardiac form and function after transcatheter closure of patent ductus arteriosus with domestic occluder, the effect of perindopril on left cardiac remodelling and pulmonary hypertension. Method：Twenty patients whose sizes of PDA were more than 5mm, and age were older than seventeen years, were divided into treatment group and control group according to identical sex and age ± 5 years, two groups were regularly given Aspirin in the day before operation, 200 mg · d^-1 ×1 moth, then 100 mg · d ^-1× 5 moths, treatment group was also given perindopril 2 mg · d^-1 × 6 moths. Echocardiographic and electrocardiographic examinations were performed before and after closure of PDA, cardiac volume and ejection fraction was measured by area-length method, pulmonary systolic pressure by continuous wave Doppler according to tricuspid reflow. Result： Fifteen patients without drug have no significant difference of right cardiac diameter, LVEF, FS between before and after closure （ P 〉0.05）. The left cardiac diameter and volume, pulmonary diameter （PD）, pulmonary systolic pressure （PSP） decreased significantly （ P d0.05） between before and 24 h or 3 months after intervention, whereas they had no significant difference between 6 months and 3 months after closure （ P 〉0.05）. Left ventricular ejection fraction （LVEF） and left ventricular shorten fraction （FS） showed no significant difference during the follow-up after closure compared with those before closure （ P 〉0.05）. After 6 month therapy with perindopril, the improvement of left ventricular end diastolic and end-systolic diameter, end diastolic volume, LVEF, FS, PD, PSP were significantly different between two groups （ P 〈0.05）, baseline of both groups had no significant difference （ P 〉0.05）. Conclusion： With 6 month follow-up, Perindopril could decrease PSP and PD, improve left cardiac function, size and morphology significantly after the transcatheter closure of PDA, better clinical symptoms.